Evaluation of Factors Associated with Dual Use of E-Cigarettes in University Students

Abstract Background The World Health Organization defined smoking as the fastest spreading and longest lasting epidemic globally. It has been reported that two-thirds of all tobacco consumption in the world is in developing countries, and with today's technology, the use of electronic cigarettes (e-cigarettes) has increased rapidly among young people and adults, especially in recent years. The study aimed to evaluate the factors associated with dual use of e-cigarettes (e-cigarette plus one of the tobacco products) in university students. Methods This study was carried out with the participation of 2477 students at Eskişehir Osmangazi University in the 2019-2020 academic year, and it was designed as a nested case-control study from a study in which 49 were determined to be dual smokers. A randomized 1:3 for age and gender with 147 non-smokers (NS) and 147 classic cigarette smokers (CSS) selected by the propensity score matching method was performed, with the final sample consisting of 343 participants. Chi-square and multinomial logistic regression analyzes were used in the study. Results In the multinomial logistic regression, the belief that e-cigarettes do not help quit classical cigarette smoking was 4.0 (95% CI; 1.7 - 9.6) times higher in NS and 4.1 (1.6 - 10.0) times higher in CCS compared to dual smokers, while the belief that e-cigarettes may suppress the desire to smoke was 4.4 (1.7 - 11.2) times higher in NS and 6.8 (2.6 - 17.6) times higher in CCS. Conclusions The study determined that dual smokers were less likely to believe that e-cigarettes are more innocent than other tobacco products. While dual smokers believed that e-cigarettes might not suppress the desire to smoke, CCS believed e-cigarettes could even increase classical cigarette smoking. Key messages • Since the effects of e-cigarette use on human health are controversial, it is still a significant public health problem in developing countries. • Although it was initially marketed to help quit or reduce the use of classical cigarettes, it should be noted that e-cigarettes are also a type of tobacco product addiction.


Background:
The World Health Organization defined smoking as the fastest spreading and longest lasting epidemic globally. It has been reported that two-thirds of all tobacco consumption in the world is in developing countries, and with today's technology, the use of electronic cigarettes (e-cigarettes) has increased rapidly among young people and adults, especially in recent years. The study aimed to evaluate the factors associated with dual use of e-cigarettes (e-cigarette plus one of the tobacco products) in university students.

Methods:
This study was carried out with the participation of 2477 students at Eskiş ehir Osmangazi University in the 2019-2020 academic year, and it was designed as a nested case-control study from a study in which 49 were determined to be dual smokers. A randomized 1:3 for age and gender with 147 nonsmokers (NS) and 147 classic cigarette smokers (CSS) selected by the propensity score matching method was performed, with the final sample consisting of 343 participants. Chi-square and multinomial logistic regression analyzes were used in the study.

Results:
In the multinomial logistic regression, the belief that ecigarettes do not help quit classical cigarette smoking was 4.0 (95% CI; 1.7 -9.6) times higher in NS and 4.1 (1.6 -10.0) times higher in CCS compared to dual smokers, while the belief that e-cigarettes may suppress the desire to smoke was 4.4 (1.7 -11.2) times higher in NS and 6.8 (2.6 -17.6) times higher in CCS.

Conclusions:
The study determined that dual smokers were less likely to believe that e-cigarettes are more innocent than other tobacco products. While dual smokers believed that e-cigarettes might not suppress the desire to smoke, CCS believed e-cigarettes could even increase classical cigarette smoking. Key messages: Since the effects of e-cigarette use on human health are controversial, it is still a significant public health problem in developing countries.
Although it was initially marketed to help quit or reduce the use of classical cigarettes, it should be noted that e-cigarettes are also a type of tobacco product addiction.

Background:
Flavoured tobacco products, including innovative flavour capsule cigarettes (FCCs) and menthol cigarettes, can increase appeal and encourage smoking initiation and use. Global epidemiological data on these products are scarce.

Methods:
This study examined market trends of FCCs and menthol (non-capsule) cigarettes across 78 countries from 2010 to 2020 and assessed ecological-level factors associated with market shares of these products. Market share and retail volume data came from Euromonitor Passport and country-specific sociodemographic data come from the WHO and World Bank. Adjusted linear fixed effects panel regression analyses were used to evaluate the relationship between predictors variables and market outcomes.

Results:
Global total retail volume of FCCs increased over time (0.2% in 2010 to 4.5% in 2020) and market share was associated with year and unemployment rate and inversely associated with % urban population and smoking prevalence (p < 0.001). In contrast, menthol retail volume decreased over time (5.0% to 3.8%) and market share was associated with % urban population (p = 0.001) and inversely associated with year (p = 0.004) and unemployment rate (p = 0.017). The greatest market increase of FCCs was observed in the Americas region and among upper-middle income countries. In Europe, there was a decrease of 0.64 percentage points from 2019 to 2020.

Conclusions:
Overall, FCCs experienced substantial global growth in the recent decade, with the exception of Europe whose slight decrease may be attributable to the European Union ban on flavours in cigarettes. Findings indicate that there is a need for increased efforts to address flavours and innovative features used in tobacco products, which are known to appeal to youth.